Stomach Cancer Supportive Care Protocol

OncologyLimited Evidence
5
supplements
2
Primary
3
Supporting
1
Grade A
37
Studies

Primary Stack

Core supplements with strongest evidence
2-3g EPA+DHA daily

Anti-inflammatory; supports immune function; may help maintain weight

6 studies300 participants
2000-4000 IU daily

Immune support; often deficient in cancer patients

5 studies250 participants

Supporting Stack

Additional supplements for enhanced results
1.2-1.5g/kg/day total protein

Critical for maintaining muscle mass; gastric surgery limits intake

10 studies500 participants
If deficient: 65-100mg elemental iron daily

Anemia common after gastric surgery; only if deficient

6 studies300 participants
1000mcg daily sublingual or monthly injection

Cannot absorb B12 after total gastrectomy; requires supplementation

10 studies500 participants

How This Protocol Works

Simple Explanation

Stomach (gastric) cancer is a serious cancer affecting the stomach lining. Treatment often involves surgery that significantly impacts nutrition and requires lifelong supplementation.

TYPES:

•Adenocarcinoma (most common)
•Lymphoma
•Gastrointestinal stromal tumors (GIST)
•Carcinoid tumors

CRITICAL: Stomach cancer requires comprehensive oncological care. This protocol is SUPPORTIVE ONLY and must be coordinated with your oncology team.

TREATMENTS:

•Surgery (partial or total gastrectomy)
•Chemotherapy
•Radiation therapy
•Targeted therapy (HER2+)
•Immunotherapy

NUTRITIONAL CHALLENGES AFTER GASTRECTOMY:

•Small stomach capacity
•Dumping syndrome
•Vitamin B12 malabsorption (requires lifelong supplementation)
•Iron deficiency
•Calcium/vitamin D deficiency
•Weight loss

* Vitamin B12 is mandatory after total gastrectomy.

* Iron and calcium absorption are impaired.

* Protein intake is critical but challenging.

Expected timeline: Nutritional support is lifelong after gastrectomy.

Clinical Perspective

Stomach Cancer: Adenocarcinoma most common. Risk factors: H. pylori, smoking, diet, family history. Staging: EGD with biopsy, CT, sometimes staging laparoscopy. Treatment: surgery (D2 gastrectomy) +/- perioperative chemo; advanced - systemic therapy.

CRITICAL: Gastrectomy creates lifelong nutritional consequences. B12 supplementation mandatory after total gastrectomy (no intrinsic factor). Iron, calcium, vitamin D malabsorption common. Small frequent meals. Supplements: B12 essential; iron/calcium as needed; protein for muscle maintenance. Discuss with oncology before supplements during active treatment.

* Omega-3 (C-grade): Weight maintenance. Systematic review: (PMID: 27840029). 2-3g EPA+DHA daily.

* Vitamin D (C-grade): Immune support. Systematic review: (PMID: 28750270). 2000-4000 IU daily.

* Protein (B-grade): Muscle maintenance. Guidelines: (PMID: 28698222). 1.2-1.5g/kg/day.

* Iron (B-grade): If deficient. Review: (PMID: 28252380). Address deficiency.

* Vitamin B12 (A-grade): Mandatory post-gastrectomy. Guidelines: (PMID: 27450775). 1000mcg daily or monthly injection.

Protocol notes: B12: mandatory after total gastrectomy; sublingual or injection (oral absorption impaired). Dumping syndrome: eat slowly, avoid simple sugars, lie down after meals. Iron: may need IV iron if oral not tolerated/absorbed. Calcium: take with vitamin D; separate from iron. Small meals: 6-8 small meals daily. Weight monitoring: significant loss common; calorie-dense foods. Oncology dietitian: essential for post-gastrectomy nutrition.